COLONOSCOPY INSTRUCTIONS WITH MiraLAX ONE DAY PREPARATION IMPORTANT: Please read these instructions TWO WEEKS before your colonoscopy so you are well prepared. If you have diabetes, call your doctor to discuss blood sugar medicines. You have been scheduled for a Colonoscopy with Duke Gastroenterology (Duke GI). This is an exam of your colon (large intestine). A flexible tube will be put into your rectum. It then passes through your colon. More tests may be performed as needed. These include taking tissue samples (biopsies) and removing polyps. Call (919) 684-6437 for questions about your appointment or preparation. Duke Gastroenterology doctors perform colonoscopies at several places. Please review the appointment information enclosed. We strive to perform the safest and most careful exam for every patient. A colonoscopy may take longer for some patients than for others. As a result, your exam may not be performed at the exact time you were scheduled. We ask for your patience. Please allow at least 3 to 4 hours for your visit. DESIGNATED DRIVER ON THE DAY OF YOUR EXAM You will receive medicines during the exam to make you comfortable and sleepy. These medicines will be given by IV (a soft flexible tube in your arm). YOU MAY NOT DRIVE HOME AFTER YOU RECEIVE SEDATION. You must have a responsible adult 18 years or older with a valid driver s license who is on site through your entire procedure. This adult must stay with you for several hours after your exam. If your companion does not stay on site, you will be asked to reschedule your exam. You may not go home alone in a taxi, shuttle, van or bus. The drivers will not be responsible for you. You may not drive until the day after your exam. Some people may receive anesthesia rather than moderate sedation. Another appointment may be scheduled for a pre-anesthesia review if anesthesia is ordered for you. SPECIAL MEDICINE INSTRUCTIONS Please bring a list of your current medicines and doses the day of your exam. Follow these medicine changes prior to your exam: Blood thinners (such as Coumadin, Warfarin, Ticlid, Plavix, Lovenox, Pletal, Pradaxa, Xarelto, Persantine and Aggrenox): These may need to be stopped 1 to 10 days before your appointment. Talk to the doctor that prescribed the medicines for instruction. Iron pills: Stop taking 7 days prior to your exam. Patients with diabetes: Follow these guidelines: o Oral Medicine ( sugar pill ): Do not take the day of your exam unless otherwise instructed. o Insulin: Please call the doctor that manages your insulin to change the dose. The dose needs to be changed for both the clear liquid day and fasting time before exam. **Patients with insulin pumps need to bring their prescribed off-pump instructions.** o Check your blood sugar the morning of your exam. o Important tips to prevent low blood sugar: During the clear liquid day, drink protein. A good source of protein is clear chicken, beef or vegetable broth. Keep glucose tablets on hand for any sudden drop of blood sugar. These are available over the counter in the diabetic supplies at any Revised 11/11/2016 Page 1
pharmacy. All other prescribed medicines (such as blood pressure pills): Continue taking as usual. If you have any questions about your medicines, call the doctor who writes your prescriptions. OTHER INSTRUCTIONS; Pacemaker or Internal Defibrillator: Please bring your device information card. Give it to the nurse. Your care provider will need to know the brand name of your device prior to your exam. Blood Products: You may be unable or unwilling to accept blood products in an emergency. If so, please call The Duke Center for Blood Conservation at 919-668-2467 one week before your appointment. Children: We discourage children in patient care areas. Revised 11/11/2016 Page 2
COLONOSCOPY INSTRUCTIONS WITH MiraLAX ONE DAY PREPARATION You will need to drink a laxative solution to clean your colon prior to colonoscopy. You must drink the entire solution for the most effective cleansing. Read these instructions completely before beginning the preparation! If you have any questions, OR IF YOU HAVE KIDNEY DISEASE OR ARE ON DIALYSIS, please call GI scheduling at 919-684-6437 to review the instructions at least one week prior to your procedure. MiraLAX is a preparation that does NOT require a prescription and has been shown to be equivalent to other colonoscopy preparations. If your physician has prescribed a colonoscopy preparation for you, please follow his or her orders. It is very important you do not take two different colonoscopy preparations. For questions or concerns, call 919-684-6437. FIVE (5) DAYS BEFORE COLONOSCOPY: Begin a low fiber (restricted-residue) diet. Please see below for list of foods that are allowed. Stop fiber supplements such as Metamucil, Citrucel and Fiberall. Purchase: Dulcolax (bisacodyl, 5 mg): 2 tablets (NOT suppositories) MiraLAX powder: 1 bottle, 238 gram (8.3 ounces) Gatorade G2 (low-calorie, low-sugar): 2 bottles, 32 ounces each 10 ounces of Magnesium citrate (either liquid or powder) Clear liquids (see list below for ideas) *G2 and liquids need to be colors that are not red or purple *Pre-moistened wipes may be used to prevent skin irritation ONE (1) DAY BEFORE COLONOSCOPY: Do NOT eat SOLID FOOD. Drink only clear liquids for all meals and snacks (see list) Morning: Put the bottles of Gatorade (G2) in the refrigerator to chill. Start clear liquid diet. 3:00 pm: Take 2 Dulcolax laxative tablets with a clear beverage of your choice 5:00 pm: Pour the bottle of MiraLAX and the 2 bottles of Gatorade into a large pitcher and mix well until MiraLAX is completely dissolved. Drink one (1) 8 ounce glass every 10-15 minutes until the pitcher is gone. *If you experience nausea, slow down the pace of drinking or take a short break, then resume drinking.* *It is important to continue drinking clear liquids until bedtime.* Revised 11/11/2016 Page 3
DAY OF COLONOSCOPY: 4 hours before you leave for your procedure: Mix the Magnesium Citrate with a clear beverage of your choice and drink the entire solution. You may drink clear liquids until 2 hours before your appointment time. Follow the recommendations on the front page about your medicines. *It is important to continue drinking clear liquids* 2 hours before scheduled procedure: Take scheduled medicines with small sips of water. Then stop taking anything by mouth. CLEAR LIQUID DIET LIST: Do NOT eat or drink anything RED or PURPLE Beverages: Soft drinks orange, ginger ale, Sprite, 7-Up, Gatorade Fruit juices without pulp apple, white grape Water Soups: Low-sodium chicken or beef bouillon/broth Vegetable or soy broth Desserts: Jell-O (lemon, lime, orange; no fruit or toppings) Popsicles (no sherbet or fruit bars) Revised 11/11/2016 Page 4
Low Residue (Low Fiber) Diet Food Group Foods Allowed Foods to Avoid Milk and dairy Milk and milk products. Includes: fruited yogurt Beverages cow's milk ice cream yogurt cheese cream coffee and tea carbonated beverages any ice cream or cheese with nuts or seeds any milk products if you are lactose intolerant any beverage containing pulp or seeds, such as orange or grapefruit juice prune juice Breads, cereals, and starches apple juice nutritional supplements that contain fiber strained juice bottled water tomato juice fruit drinks without pulp, such as fruit punch Kool-Aid or Hi-C (no red or purple) nutritional supplements without added fiber, such as Boost or Ensure refined breads, rolls, bagels, English muffins, pita bread, biscuits, muffins, crackers, pancakes, waffles, or pastry whole grain breads, cereals, and pasta refined cooked and cold cereals such as hominy grits, farina, cream of wheat or rice, strained oatmeal, Cheerios, Corn/Rice Chex, Cornflakes, Rice Krispies, Special K oatmeal potato and sweet potato without skin granola any bread, cereal, cracker, or pasta made with seeds, nuts, coconut, or raw or dried white rice fruit refined pasta corn bread refined pasta graham crackers brown rice wheat germ bran sprouted wheat wild rice barley potato skins Revised 11/11/2016 Page 5
Low Residue (Low Fiber) Diet Food Group Foods Allowed Foods to Avoid Fruits canned or cooked fruit without skins or seeds (peaches, pears, apricots, apples) raw fruit (bananas are okay) applesauce canned pineapple, oranges, grapefruit sections, mixed fruit ripe banana dried fruit jellied cranberry sauce all berries, melons whole cranberry sauce avocado coconut Vegetables tender, well cooked fresh, canned and frozen vegetables without seeds such as peeled carrots, green beans, and beets all raw vegetables, such as lettuce, onion, celery, cucumber, mushrooms, scallions, etc. strained vegetable juice vegetables with seeds Meat and meat substitutes strained tomato juice cooked, tender fish, poultry, beef, lamb, pork, ham, veal, organ meats eggs cheese tofu tuna fish smooth peanut butter and other smooth nut butters tough, fibrous cooked vegetables such as: artichokes, asparagus, broad beans, broccoli, cauliflower, brussel sprouts, celery, corn, cucumber, eggplant, mushrooms, onion, peas (grean peas), sauerkraut and cabbage, spinach, tomatoes, zucchini summer squash, winter squash non-tender meats gristle hot dogs salami, cold cuts meat substitutes made with whole grains, nuts, or seeds dried beans, peas, lentils crunchy style peanut butter and other crunchy nut butters Miscellaneous salt, sugar, ground or flaked herbs and spices pepper vinegar seed spices ketchup and mustard seeds and nuts soy sauce coconut jelly (but not jam or preserves) popcorn jams or preservces pickles and olives Revised 11/11/2016 Page 6